This book provides a comprehensive examination of the ways that health policy has been shaped by the political, socioeconomic, and ideological environment of the United States. The roles played by public and private, institutional and individual actors in designing the healthcare system are identified at all levels. The book addresses the key problems of healthcare cost, access, and quality through analyses of Medicare, Medicaid, the Veterans Health Administration, and other programs, and the ethical and cost implications of advances in healthcare technology. This fully updated fourth edition gives expanded attention to the fiscal and financial impact of high healthcare costs and the struggle for healthcare reform, culminating in the passage of the Affordable Care Act, with preliminary discussion of implementation issues associated with the Affordable Care Act as well as attempts to defund and repeal it. Each chapter concludes with discussion questions and a comprehensive reference list. Helpful appendices provide a guide to websites and a chronology. PowerPoint slides and other instructional materials are available to instructors who adopt the book.